Key result
QRS area reduction strongly correlates with acute hemodynamic response during biventricular pacing.
Why the study?
Reduction in QRS area after CRT improves long-term outcomes, but whether it reflects hemodynamic improvement across LV pacing sites and can guide lead placement was unknown.
Does reduction in QRS area correlate with acute hemodynamic improvement during biventricular pacing at different LV sites in patients with a CRT indication?
Observational (n=52)
Yes
Does reduction in QRS area correlate with acute hemodynamic improvement during biventricular pacing at different LV sites in patients with a CRT indication?
Effect estimate: median R = 0.76
p-value: p=<0.0001
Reduction in QRS area during biventricular pacing strongly correlates with acute hemodynamic improvement, suggesting it could serve as a noninvasive marker to guide optimal LV lead placement in CRT.
QRS area reduction may guide LV lead placement in CRT; leaves open prospective validation of clinical outcomes.
Background: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and can be used to guide LV lead placement. Methods: Patients with a class Ia/IIa CRT indication were prospectively included from three hospitals. Acute hemodynamic response was assessed as the relative change in maximum rate of rise of left ventricular (LV) pressure (%∆LVdP/dtmax). Change in QRS area (∆QRS area), in QRS duration (∆QRS duration), and %∆LVdP/dtmax were studied in relation to different LV pacing locations within a patient. Results: Data from 52 patients paced at 188 different LV pacing sites were investigated. Lateral LV pacing resulted in a larger %∆LVdP/dtmax than anterior or posterior pacing (p = 0.0007). A similar trend was found for ∆QRS area (p = 0.001) but not for ∆QRS duration (p = 0.23). Pacing from the proximal electrode pair resulted in a larger %∆LVdP/dtmax (p = 0.004), and ∆QRS area (p = 0.003) but not ∆QRS duration (p = 0.77). Within patients, correlation between ∆QRS area and %∆LVdP/dtmax was 0.76 (median, IQR 0.35; 0,89). Conclusion: Within patients, ∆QRS area is associated with %∆LVdP/dtmax at different LV pacing locations. Therefore, QRS area, which is an easily, noninvasively obtainable and objective parameter, may be useful to guide LV lead placement in CRT.
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Ghossein et al. (2021) conducted an observational in Heart failure with class Ia/IIa CRT indication (n=52). Left ventricular pacing at different anatomical sites vs. Alternative pacing sites within the same patient was evaluated on Correlation between change in QRS area (∆QRS area) and relative change in maximum rate of rise of left ventricular pressure (%∆LVdP/dtmax) (median R = 0.76, p=<0.0001). Reduction in QRS area during biventricular pacing strongly correlated with acute hemodynamic improvement (median R = 0.76), suggesting QRS area can guide optimal left ventricular lead placement.
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